JMIR Publications

ABSTRACT

Background:

Body dissatisfaction (BD) and body dysmorphic disorder (BDD) are common and impairing mental health conditions. However, access to effective, evidence-based face-to-face treatments remains limited due to significant treatment barriers. Mobile health applications (MHA) available in commercial app stores may offer low-threshold, scalable intervention options. Yet, the opaque nature of the app market makes it difficult to identify high-quality MHA. Further, therapeutic apps are often presented alongside non-therapeutic—and potentially harmful—apps that focus on appearance alteration (e.g., image filters), further complicating safe, informed user choices.

Objective:

This study aimed to evaluate general characteristics (including app safety, privacy, and persuasive design features), quality, evidence base and therapeutic content of MHA addressing BD and BDD, including a risk evaluation for available non-therapeutic apps, to guide users and clinicians toward reliable resources.

Methods:

We conducted a systematic search of the German Google Play and Apple App stores to identify German and English MHA. Two trained independent reviewers assessed content, quality, and other pertinent features (e.g., evidence base, safety features) via the German Mobile Application Rating Scale (MARS-G), evaluating engagement, functionality, aesthetics, information quality, as well as perceived impact, subjective quality and therapeutic gain.

Results:

Of N = 2417 apps identified, only n = 10 (0.41%) met inclusion criteria as MHA, while n = 295 apps (12.2%) were classified as non-therapeutic health-related apps, yielding a ratio of 1:30 when searching for BD or BDD in the common markets. Overall, most MHA were commercially developed, based in cognitive-behavioral therapy, targeted at BD and female users, with variable privacy features and limited language and cost accessibility. MHA quality was moderate (M = 3.57, SD = 0.65), with highest scores for functionality (M = 4.15, SD = 0.56) and lowest for information quality (M = 2.84, SD = 0.89) and therapeutic gain (M = 2.39, SD = 0.91). There were no significant bivariate correlations between app quality and app-store user satisfaction ratings (all rs < 0.45; all P > 0.70). Only 40% of MHA were evidence-based, despite 80% of them making health claims. MHA included, on average, 4.8 out of 8 evidence-based therapeutic strategies, with core components of BDD treatment - like exposure and relapse prevention - being underrepresented.

Conclusions:

High-quality MHA for body BD and BDD are scarce, while users are frequently exposed to potentially harmful non-therapeutic apps in commercial app stores. Most MHA lack critical safety features, personalization, and empirical support. These findings underscore the urgent need for consistent app store regulation efforts, including transparent labeling, and the development of evidence-based, safe, and accessible MHA for BD and BDD.